Compounding device system

ABSTRACT

A system for compounding medications. The system includes one or more compounding devices, and a central computer system. The central computer system receives requests, at least some of which require the compounding of one or more medications, and pushes assignments of respective compounding tasks to the one or more compounding devices. The assignments are made in accordance with a set of rules designed to promote efficient use of compounding resources.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a divisional of U.S. patent application Ser. No.17/209,625, filed Mar. 23, 2021 and titled “Compounding Device System,”which is a continuation of U.S. patent application Ser. No. 16/792,519,filed Feb. 17, 2020 and titled “ Compounding Device System,” which is acontinuation of U.S. patent application Ser. No. 16/207,016, filed Nov.30, 2018 and titled “Compounding Device System,” which is acontinuation-in-part of U.S. patent application Ser. No. 15/865,038,filed Jan. 8, 2018 and titled “Multi-Camera Imaging for IV Compounding,”which claims priority to Italian patent application no. 102017000134813filed Nov. 23, 2017, and U.S. patent application Ser. No. 16/207,016,filed Nov. 30, 2018 and titled “Compounding Device System” claims thebenefit of Provisional U.S. Patent Application No. 62/592,609 filed Nov.30, 2017 and titled “Compounding Device System,” the entire disclosuresof which are hereby incorporated by reference herein for all purposes.

BACKGROUND OF THE INVENTION

Pharmaceutical compounding is the preparation of patient-specificmedications by the processing or combination of ingredients. Manymedications, especially medications administered orally in pill form,are now manufactured in a variety of forms and dosages so that littlepreparation is needed at a pharmacy, other than placing the propernumber of pills in a bottle to fill a doctor's prescription for aparticular patient. However, medications for intravenous delivery areroutinely compounded, for example in hospital pharmacies.

Typically, a physician will prescribe a particular medication or acombination of medications for a specific patient, for intravenous (IV)delivery. The pharmacy receives the prescription and prepares the IVsolution with the proper amount of each prescribed medication. Thecompounded medication is then sent to the hospital floor foradministration to the patient.

It is of utmost importance that the correct medications be prepared inthe correct proportions, without the introduction of contaminants.Detailed protocols may be developed for the compounder to follow. Thenumber of different protocols may be very large, because there may be alarge number of different medications to choose from, in a variety ofpackages, to be prepared in a number of dosages, and to be provided in anumber of different delivery vehicles.

Much of the work of compounding may be delegated to workers who are notregistered pharmacists, or to robotic machines. Accordingly meticulousrecords may be kept of the preparation of each medication, so that thepharmacist can review how each medication was made before it leaves thepharmacy. The records also enable review of the preparation of anyparticular medication at a later time, should there be any question ofits correctness.

In addition, it is desirable that pharmacy resources be usedefficiently, and that excessive waste of medications and supplies beavoided.

BRIEF SUMMARY OF THE INVENTION

A system for compounding of medications comprises one or morecompounding devices, and a computer. Each of the one or more compoundingdevices is in bidirectional communication with the computer via anelectronic network. The computer is configured to receive a plurality ofrequests, at least some of which require the compounding of one or moremedications, and for each of the received requests, push, via theelectronic network, an assignment of a respective compounding task toone of the one or more compounding devices. The computer is configuredto assign respective compounding tasks in accordance with a set of rulesdesigned to promote efficient use of compounding resources.

BRIEF DESCRIPTION OF THE DRAWINGS

The patent or application file contains at least one drawing executed incolor. Copies of this patent or patent application publication withcolor drawing(s) will be provided by the Office upon request and paymentof the necessary fee.

FIG. 1 illustrates a compounding pharmacy in accordance with embodimentsof the invention.

FIG. 2 illustrates a manual compounding station in accordance withembodiments of the invention.

FIG. 3 shows a compounding assistance device, in accordance withembodiments of the invention.

FIG. 4 shows a lower oblique view of the compounding assistance deviceof FIG. 3 , in accordance with embodiments of the invention.

FIG. 5 illustrates bar code scanning by the compounding assistancedevice of FIG. 3 , in accordance with embodiments of the invention.

FIG. 6 illustrates a step in a compounding process, in accordance withembodiments of the invention.

FIG. 7 illustrates another step in the compounding process, inaccordance with embodiments of the invention.

FIG. 8 illustrates another step in the compounding process, inaccordance with embodiments of the invention.

FIG. 9 illustrates another step in the compounding process, inaccordance with embodiments of the invention.

FIG. 10 shows a photograph as may be taken using a visible light camera,in accordance with embodiments of the invention.

FIG. 11 shows a photograph of a syringe as may be taken using aninfrared camera, in accordance with embodiments of the invention.

FIG. 12 illustrates another step in the compounding process, inaccordance with embodiments of the invention.

FIG. 13 illustrates another step in the compounding process, inaccordance with embodiments of the invention.

FIG. 14 illustrates the arrangement of an area light source and aninfrared camera of the compounding assistance device of FIG. 3 , in anembodiment of the invention.

FIG. 15 shows a photograph similar to the photograph of FIG. 11 , takenusing an infrared camera, and illustrating image analysis in accordancewith embodiments of the invention.

FIG. 16 illustrates an example of a trace of the brightness of pixelsalong a column line in the image of FIG. 15 , in accordance withembodiments of the invention.

FIG. 17 illustrates a way of annotating an infrared image, in accordancewith embodiments of the invention.

FIG. 18 illustrates the arrangement of a visible light camera in thecompounding assistance device of FIG. 3 , in an embodiment of theinvention.

FIG. 19 shows an example photograph of a number of syringes, as may betaken by a visible light camera in accordance with embodiments of theinvention.

FIG. 20 illustrates a simplified block diagram of the compoundingassistance device of FIG. 3 , in accordance with embodiments of theinvention.

FIG. 21 schematically shows one example arrangement of multiplepharmacies in multiple facilities, all in communication with a pharmacyserver, in accordance with embodiments of the invention.

FIG. 22 illustrates a high-level block diagram of a resource controlsystem, in accordance with disclosed embodiments.

FIG. 23 shows a diagram of a portion of an architecture stack of thesystem if FIG. 22 , in accordance with certain embodiments.

DETAILED DESCRIPTION OF THE INVENTION

FIG. 1 illustrates a compounding pharmacy 100 in accordance withembodiments of the invention. The operation of pharmacy 100 iscoordinated by a pharmacy server 101, described in more detail below.Pharmacy server 101 receives orders for compounded medications, forexample prescriptions from physicians. Pharmacy server 101 maintainsextensive records of orders received, detailed protocols for thecompounding of medications, records of the preparation of medications inresponse to orders, and other items. Pharmacy server 101 also allocatestasks to one or more compounding stations, which may include manualcompounding stations such as stations 102 a and 102 b, and one or morerobotic compounders 103. The compounding stations may also reportinformation to pharmacy server 101, for example records of thecompounding of each ordered medication.

Pharmacy server 101 includes a processor 105 and memory 106. Memory 106holds instructions that, when executed by processor 105, cause pharmacyserver 101 to perform its functions in accordance with embodiments ofthe invention. Memory 106 may also hold the records, protocols, andother information collected and generated in the operation of pharmacy100. For the purposes of this disclosure, the term “memory” encompassesmany different kinds of data storage devices and combinations of suchdevices, for example dynamic memory, static memory, volatile memory,nonvolatile memory, and mass storage such as magnetic or optical diskstorage or tape storage.

While pharmacy server 101 is shown as a single block in FIG. 1 and couldbe a single, stand-alone computer system having memory 106 and one ormore processors 105, other implementations are possible. For example,pharmacy server 101 may be implemented using a number of interconnectedcomputers, either co-located or in multiple locations. In particular,pharmacy server 101 may be implemented as a “cloud” service, in whichthe functions of pharmacy server 101 may be performed by differentprocessors at different times, and memory 106 may be distributed aswell. Pharmacy server 101 presents information to a user via a userinterface shown on an electronic display 107, and may receive inputsfrom the user via any input device or devices 108, for example akeyboard, mouse, other pointing device, or other input devices orcombinations of input devices.

Working materials are supplied to the compounding stations from a supplystore 104. Pharmacy server 101 may maintain an inventory of thematerials in supply store 104, and may track the movements ofmedications and supplies within pharmacy 100.

Finished products are reviewed by the pharmacist and delivered frompharmacy 100 to their points of use, for example patient rooms foradministration by a nurse to a patient. It will be understood that theabove description is highly generalized, and that a working compoundingpharmacy may have many other systems and facilities.

FIG. 2 illustrates a manual compounding station 102 a in accordance withembodiments of the invention. Compounding station 102 a includes acompounding assistance device 201 on a surface 202. For the purposes ofthis disclosure, a compounding assistance device is an electromechanicaldevice having features and capabilities for facilitating the performanceof a compounding task by a human operator. Compounding assistance device201 may be placed under a laminar flow hood 203, which flows filteredair over compounding assistance device 201 and surface 202, to helpavoid contamination of the materials being worked on, and for protectionof the user of compounding station 102 a.

In the example shown, compounding station 102 a has received suppliesfor a simple compounding task. A medication supplied in a vial 204 is tobe added to an IV drip bag 205. A syringe 206 may be used to accomplishthe transfer.

Compounding assistance device 201 has several features and capabilitiesthat will assist the compounder in properly preparing the formulation inIV drip bag 205, and in thoroughly documenting the process. Compoundingassistance device 201 has a network connection 207 to pharmacy server101, through which compounding assistance device 201 may receive aprotocol from pharmacy server 101 describing the steps required toperform the compounding task.

For the purposes of this disclosure, a protocol is a sequence of stepsfor a specific compounding task involving a specific medication. Aworkflow is a generic set of steps, specified independent of theparticular medication and dosage of the specific compounding task. Oneworkflow can describe the generic steps required for a kind ofcompounding task. Many different protocols may implement the workflow,for specific medications and amounts. For example, a particular workflowmay describe the high level steps needed to draw medication from a vialand add it to an IV drip bag. Separate protocols can then describe thesteps for placing a specific dosage of a specific medication in the dripbag.

Compounding assistance device 201 includes a display screen 208 on whichinstructions to the user may be presented or through which the user mayinput information. For example, display screen 208 may be a touchscreendisplay, sensitive to touch and able to distinguish the location of atouch. Compounding assistance device 201 also includes a tray 209 whichprovides a carrier for holding items while they are weighed orphotographed, as is described in more detail below.

FIG. 3 shows compounding assistance device 201, with tray 209 removed,in accordance with embodiments of the invention. Visible in FIG. 3 is aweight sensor 301, for example a load cell, for weighing tray 209 andits contents. Also visible is an area light source 302. Area lightsource 302 is a two-dimensional extended or area light source, and emitslight from many points or continuously across its face. Area lightsource 302 may be, for example, an infrared light panel, illuminating aportion of tray 209 from below with infrared light.

FIG. 4 shows a lower oblique view of compounding assistance device 201,in accordance with embodiments of the invention. A gantry 401 spans tray209. Positioned on gantry 401 are a bar code scanner 402, a visiblelight camera 403, and an infrared camera 404. Visible light camera 403may further include one or more light sources 405 for illuminating atleast a portion of tray 209 from above. Light sources 405 may be, forexample, one or more white-light light emitting diodes (LEDs)surrounding visible light camera 403, or another kind of light source.For the purposes of this disclosure, light is “visible” if it includeslight wavelengths between about 400 and 700 nanometers. Light is “white”if it includes enough wavelengths in the visible range to enablereasonably complete color recognition.

The area above tray 209 may be called a viewing area for items to bephotographed by infrared camera 404 or visible light camera 403, orscanned by bar code scanner 402. In other embodiments, an item may notnecessarily be lit from below and photographed from above. For example,in a compounding robot, a robotic mechanism may hold an item to bephotographed in the field of view of a camera in any orientation. Forexample, an item may be photographed from below, or horizontally.

Bar code scanner 402 is positioned to read bar codes on items held inthe viewing area between tray 209 and bar code scanner 402. Visiblelight camera 403 and infrared camera 404 are position to takephotographs of items on tray 209.

During compounding of a medication one or more of weight sensor 301, barcode scanner 402, visible light camera 403, and infrared camera 404 canbe used to provide documentation of how the medication was compounded,and to avoid errors.

For example, to perform the compounding task illustrated in FIG. 2 ,pharmacy server 101 sends detailed sequential instructions tocompounding assistance device 201, which then leads the user through thesteps required to formulate the specific medication in the specific doserequired, for delivery in the specific delivery vehicle. In thisexample, the task may involve transferring 30000 units of Heparin (acommon anticoagulant) from a vial containing 5000 units/ml of Heparin insolution, to an IV drip bag. The volume of solution required fortransfer is therefore 6 ml. Vial 204 and IV drip bag 205 have beensupplied to compounding station 102a, along with syringe 206, which willbe needed to make the transfer.

First, compounding assistance device 201 requires that the user presentvial 204 to bar code scanner 402, so that the identifying bar code onvial 204 can be read, and the system can verify that the correct vialwith the correct concentration has been provided. If not, then an errormessage is generated and the compounding task is stopped. The scanningprocess is illustrated in FIG. 5 , along with an example prompt shown onscreen 208. Compounding assistance device 201 may automaticallyrecognize that the barcode has been detected, and may move to the nextstep. Alternatively, an acknowledgment from the user may be required, inthis and other steps.

FIG. 6 illustrates a second step in the compounding process, in which aninitial weight of vial 204 is collected. For this purpose, vial 204 isplaced on tray 209. Tray 209 may include an icon 601 indicating wherevial 204 should be placed, and may also include mechanical features foraiding in proper placement of vial 204. For example, a gently V-shapedtrough may be formed into tray 209. Compounding assistance device 201may automatically recognize the weight of vial 204 on tray 209, recordthe weight, and move to then next step of the compounding process.

In some embodiments, vial 204 may also be photographed while on tray 209using visible light camera 403, using ambient light, light from lightsources 405, or a combination thereof

FIG. 7 illustrates a third step, in which an initial weight of IV bag205 is collected. Compounding assistance device 201 may then prompt theuser to draw the correct amount (6 ml) of solution from vial 204 intosyringe 206.

FIG. 8 illustrates a fourth step, in which an after-drawn weight of vial204 is taken, in a manner similar to the taking of the initial vialweight shown in FIG. 6 . The system can compare the two weights of vial204 to calculate the amount of solution drawn from vial 204, forrecordkeeping and for verification that the proper amount of solutionwas drawn.

FIG. 9 illustrates a fifth step, in which the filled syringe isphotographed. For this purpose, tray 209 may include an icon 901 forplacement of syringe 206, and may include mechanical featuresfacilitating correct placement and alignment of syringe 206 on tray 209,for example a V-shaped trough, or a groove 902 shaped and sized toreceive an edge of the barrel flange of syringe 206. Other fiducialmarks may be present as well.

Syringe 206 may be photographed using visible light camera 403, but ispreferably photographed using infrared camera 404. FIG. 10 shows aphotograph as may be taken using visible light camera 403. (Visiblelight camera 403 preferably has a field of view larger than shown inFIG. 10 , but syringe 206 has been isolated from the larger view forease of explanation.) While syringe 206 is readily visible in thephotograph of FIG. 10 , the photograph has been affected by glare spot1001, and may have been affected by ambient light sources that are notunder the control of compounding assistance device 201.

FIG. 11 shows a photograph of syringe 206 as may be taken using infraredcamera 404. Tray 209 is not opaque to infrared radiation, so syringe 206is backlit by infrared light source 302. For example, tray 209 may besubstantially transparent to infrared radiation, or may be translucent.In some embodiments, tray 209 may be made of polycarbonate or anothersuitable polymer or blend of polymers. Infrared camera 404 may have awavelength-selective optical filter that passes infrared light to camera404, but blocks the visible spectrum. Thus, glare spots formed fromvisible light are excluded from the photograph of FIG. 11 , resulting ingreater clarity of features of syringe 206.

Whichever kind of camera is used, compounding assistance device 201 canautomatically analyze the resulting photograph for any of a number ofpurposes. For example (referring to FIG. 11 ), the position of theplunger 1101 of syringe 206 may be automatically recognized, and theamount of drawn liquid 1102 calculated based on the known dimensions ofsyringe 206. In some embodiments, bubbles such as bubble 1103 may bedetected and flagged if they are large enough to significantly affectthe dose of medication being prepared. In some protocols, the weight ofsyringe 206 before and after drawing liquid from vial 204 may be used toverify that the correct amount of liquid was placed into syringe 206. Inthat case, compounding assistance device 201 may also photograph syringe206 at each weighing and analyze the photographs to detect whethersyringe cap 1104 may have been mistakenly included in one weighing butnot another. Fiducial marks 1105 on tray 209 are placed in knownpositions, and may be detected in the photograph and used to calibratedistances in the photograph.

FIG. 12 illustrates a sixth step, in which IV bag 205 is re-weighedafter addition of solution from syringe 206. Compounding assistancedevice 201 can compare the before and after weights of bag 205 to verifythat the correct amount of Heparin solution was placed into bag 205.

FIG. 13 illustrates a seventh step, in which (presuming all of thechecks in the system have verified that the compounding process was donecorrectly) compounding assistance device 201 prints a label 1301 usinglabel printer 1303, to be placed on bag 205, and the user is prompted toadhere label 1301 to bag 205. The finished medication can then bedelivered to its point of use, and any consumable items disposed of, forexample syringe 206. The user may be asked to confirm 1302 that label1301 has been affixed, using display 208. In some embodiments, a finalphotograph of completed bag 205 may be taken for pharmacist review.

The compounding process described above is but one example, and manydifferent compounding workflows may be implemented that have differentsteps, that use different medication containers, that collect differentor additional information for process verification, or that differ inother ways from the example shown.

While the above example was shown in the context of compoundingworkstation 102 a, a similar process may be followed for compoundingusing a robotic compounder such as robotic compounder 103 shown in FIG.1 . A robotic compounder is a machine, usually enclosed, that use arobotic mechanism to handle vials, syringes, bags, and the like toprepare compounded medications. A robotic compounder may include ascale, one or more cameras, agitation devices, disposal ports, materialand supply loading windows, and a delivery window for delivering afinished medication. Robotic compounders are not subject to human errorin the compounding process, but include various weight and photographicchecks on their work to guard against improper loading of materials,mechanical malfunctions, programming errors, and the like.

Whether compounding is done manually or robotically, the data collectedduring the compounding process is stored, for example on pharmacy server101, and can be reviewed by the responsible pharmacist. For example, thepharmacist can verify that the correct kind of vial containing thecorrect medication was identified by the barcode scan. The dosage can beverified by looking at the photograph of the syringe, the before andafter weights of the vial, the before and after weights of the bag, orany combination of these. Any digital photographs taken during thecompounding process may be made available for inspection by thepharmacist. For example, the pharmacist may look at a photograph such asthe photograph of FIG. 11 to determine whether excessive bubbles mayhave been included in the liquid drawn into syringe 206.

Upon completion of the compounding task, pharmacy server 101 may assignanother compounding task to compounding station 102 a, and downloadanother protocol to compounding assistance device 201 in accordance withthe new task.

FIG. 14 illustrates the arrangement of area light source 302 andinfrared camera 404 of compounding assistance device 201, in anembodiment of the invention.

In this example, area light source 302 includes an array of infraredlight emitting diodes (LEDs) 1401 mounted to a circuit board 1402. Lightfrom infrared LEDs 1401 passes through a diffuser 1403, and is scatteredupward. Some of the light reaches a lens 1404 of infrared camera 404,which forms an image onto an electronic array light sensor 1405, whichin turn is mounted on a printed circuit board 1406. Printed circuitboard 1406 may interface with a controller within compounding assistancedevice 201, to receive signals for controlling electronic array lightsensor 1405.

Infrared LEDs 1401 may emit light in the near infrared wavelengths, forexample between about 700 and 900 nanometers. In other embodiments,other wavelengths may be used. Diffuser 1403 provides a generallyuniform backlight for items placed on area light source 302, for examplesyringe 206. Area light source 302 may be controlled by an electroniccontroller within compounding assistance device 201. In someembodiments, tray 209 may be made of a diffusing material, and may beused in addition to or instead of diffuser 1403 to diffuse the lightfrom area light source 302.

In other embodiments, other kinds of light sources may be used, forexample an edge-lit light guide plate having scattering features on oneside. In this arrangement, light sources direct light into one or moreedges of the light guide plate, and the light propagates by totalinternal reflection within the plate until it strikes one of thescattering features. Some of the scattered light is scattered out of theside of the plate opposite the scattering features. The scatteringfeatures are preferably distributed so that the intensity of the lightexiting the plate is substantially uniform across the area of the plate.A diffuser may also be used to further diffuse the light exiting theplate, for additional uniformity in brightness.

Electronic array light sensor 1405 may be, for example, a charge coupleddevice (CCD) sensor, a complementary metal oxide semiconductor (CMOS)sensor, or another suitable kind of sensor. In general, such sensorsexploit the property of some semiconductor materials that when thematerial is struck by light, free electrons are generated in proportionto the intensity of the light. The sensor is divided into specificlight-sensitive areas called “pixels”. To capture an image, the pixelsare reset and then exposed to light for an exposure time. At the end ofthe exposure time, the amount of charge accumulated in each pixel ismeasured and converted to a numerical value. An array of these numericalvalues may be called a “digital image”, with each value in the arrayrepresenting the brightness of the light falling on the correspondingpixel.

In a CCD sensor, the accumulated charges are shifted off of the sensorto a charge amplifier, the output of which is digitized for each pixel.In a CMOS sensor, the accumulated charge can be read from each pixeldirectly, without shifting.

Electronic array light sensor 1405 may have any number of pixelssufficient to resolve features of interest at tray 209. In someembodiments, electronic array light sensor 1405 may include an array2560 X 1920 pixels, or about five megapixels. Other array sizes may beused in other embodiments. Electronic array light sensor 1405 issensitive to light in the infrared wavelengths emitted by area lightsource 302. For example, electronic array light sensor 1405 may be asilicon-based sensor sensitive to near infrared light. Infrared camera404 may include an optical filter (not shown) that excludes otherwavelengths. The optical filter may be, for example, a dichroic filterthat passes light in the wavelengths of interest, but blocks light inother wavelengths, for example visible light.

As is explained above, infrared camera 404 can produce photographs ofitems on tray 209 that may be clearer in some aspects relevant topharmaceutical compounding than photographs taken using visible lightcamera 403. For example, glare spots caused by ambient room light can belargely eliminated. This clarity facilitates analysis of the digitalphotographs taken using infrared camera 404 for measurement andannotation that may be helpful to a reviewing pharmacist.

FIG. 15 shows a photograph similar to the photograph of FIG. 11 , takenusing an infrared camera such as infrared camera 404, and illustratingimage analysis in accordance with embodiments of the invention. Thecontroller within compounding assistance device 201 may “know” therelative positions of fiducial marks 1105, as measured in image pixels,based on the known locations of fiducial marks 1105 on tray 209, thenumber of pixels in electronic image sensor 1405, and the magnificationof the optical system including lens 1404. The controller can quicklylocate the fiducial marks in the image by looking for a pattern of darkspots near the expected locations of the fiducial marks in the image.The pixel locations of the fiducial marks in the image may be recordedfor reference.

As is visible in FIG. 15 , barrel flange 1501 of syringe 206 has beenplaced in groove 902 of tray 209, and thus barrel flange 1501 isprecisely located with respect to fiducial marks 1105 in the “X”direction shown in FIG. 15 . The controller may then query thebrightness values of the pixels in the image near the fiducial marks, tolocate edges of syringe 206 in the “Y” direction. For example, pixelsalong column lines 1502, 1503, and 1504 may be analyzed, looking forabrupt light-to-dark and dark-to-light transitions that indicate thepresence of edges of parts of syringe 206.

FIG. 16 illustrates an example of a trace of the brightness of pixelsalong column line 1502, moving in the +Y direction from lower leftfiducial mark 1505. The transitions spanned by width W may be presumedto include be the needle of syringe 206. If no drop in brightness isdetected at the expected location of the needle, then the controller mayconsider that no needle is attached to syringe 206. Presuming a drop isdetected, then the centerline of the region spanned by width W may bepresumed to be the centerline of the needle. The width W may be comparedwith known dimensions of the parts of syringe to determine whether a capis present on the needle.

Referring again to FIG. 15 , similar traces may be performed along otherlines to detect the presence and size of a luer lock 1506, or thepresence and size of a plunger (not labeled) of syringe 206. Thedetected dimensions may be compared with stored dimensions of standardsyringes, so that the size of syringe 206 is automatically determined.

In other embodiments, other image processing techniques may be used toascertain the location and size of a syringe from a digital image. Forexample, a correlation operation may be performed with apreviously-prepared syringe photograph. The previous photograph may becompared with the current photograph in a number of orientations andpositions, to find the location that best correlates with the syringe inthe current photograph, to ascertain the location of the syringe in thecurrent photograph. Fiducial marks 1105 may be found in this way aswell. In other embodiments, a synthetic syringe image may be used in thecorrelation operation. Many other techniques are possible.

Once the size and location of syringe 206 are known in pixel space, thecontroller may annotate the digital image of the syringe, to assist thepharmacist in reviewing the compounding operation in which the image wastaken.

In some embodiments, similar image processing techniques may be used tolocate plunger 1507 in the digital image. Given the location of plunger1507, the location and orientation of syringe 206, and the size ofsyringe 206, an estimate of the volume of liquid in syringe 206 can becomputed.

FIG. 17 illustrates one way of annotating an infrared image, inaccordance with embodiments of the invention. Once the size and locationof syringe 206 have been ascertained, the size can be correlated to astandard syringe having pre-recorded measurements, including thelocations of gradation marks 1701 on the syringe barrel indicatingvolumes of liquid in the syringe based on plunger position. Whilegradation marks 1701 are highly visible in FIG. 17 , this may not alwaysbe the case. Depending on the positioning of the syringe on tray 209,gradation marks 1701 may not be readily visible in any images. Forexample, syringe 206 may have been placed on tray 209 with gradationmarks 1701 facing downward, or the liquid within syringe 206 may beopaque, hiding gradation marks 1701.

Using the known size and position of syringe 206, compounding assistancedevice 201 can annotate images taken by either of its cameras to enhancethe readability of the plunger position. In FIG. 17 , compoundingassistance device has altered some of the pixels of the image to showlines 1702 corresponding to the computed locations of gradation marks1701, and has also added text 1703 showing the liquid volumesrepresented by lines 1702. In other embodiments, other kinds ofannotation may be provided, for example using different colors.

FIG. 18 illustrates the arrangement of visible light camera 403 ofcompounding assistance device 201, in an embodiment of the invention.Visible light camera 403 may be used to photograph items on tray 209,for verification that the correct ingredients were used in a compoundingtask, for final verification that the resulting product looks as itshould, or for other purposes. Visible light camera 403 may be a colorcamera, and may be especially useful for recording the color of aformulation as additional verification that the formulation is likelycorrect. (Example infrared camera 404 as described above cannotdistinguish color due to the narrow band of infrared wavelengths itrecords and the lack of any color filters on its pixels.)

Visible light camera 403 includes a lens 1801 that focuses lightreceived within its field of view onto an electronic sensor array lightsensor 1802, which is in turn mounted on a printed circuit board 1803.Visible light camera 403 may include an optical filter (not shown) suchas a dichroic filter that substantially prevents infrared wavelengthsfrom reaching sensor 1802. Light sources 405 may be used to supplementany ambient light illuminating tray 209. For example, light sources 405may be white LEDs directed at tray 209, and controllable by thecontroller within compounding assistance device 201.

Electronic array light sensor 1802 may be a CCD sensor, a CMOS sensor,or another suitable kind of sensor as described above, having enoughpixels to resolve features of interest at tray 209. For example, sensor1802 may include an array 2560×1920 pixels, or about five megapixels.Other sensor sizes may be used. Sensor 1802 preferably includes colorfilters placed over individual pixels so that visible light camera 403can record color images. For example, sensor 1802 may include red,green, and blue filters in the well-known Bayer pattern.

Visible light camera 403 and infrared camera 404 may be provided aspre-assembled camera modules that include standard interfaces forcontrol by compounding assistance device 201. Suitable camera modulesare available from Basler AG of Ahrensburg, Germany, and IDS ImagingDevelopment Systems GmbH of Obersulm, Germany.

FIG. 19 shows an example photograph of a number of syringes 1901 a-1901f as may be taken by visible light camera 403 using light sources 405.Each of syringes 1901 a-1901 f contains fluid of a different color.Although the fluids in FIG. 19 are not necessarily pharmaceuticals, FIG.19 illustrates that visible light camera 403 can distinguish a widerange of colors, and a photograph taken with visible light camera 403may enable a pharmacist to verify that a compounded liquid is of anexpected color, bolstering confidence that the compounding was donecorrectly, or to detect that a compounded liquid is not of the expectedcolor, indicating that the compounding may not have been done correctly.

FIG. 20 illustrates a simplified block diagram of compounding assistancedevice 201, in accordance with embodiments of the invention. Compoundingassistance device 201 includes a controller 2001 comprising a processor2002, memory 2003, and a network interface 2004. Memory 2003 may includedynamic memory, non-volatile memory, mass storage, or other kinds ofmemory in any suitable combination. Part of memory 2003 holdsinstructions for processor 2002 that, when executed, control theoperation of compounding assistance device 201. Other kinds ofinformation may be stored in memory 2003 as well, for example workingcopies of digital images, temporary variables, and other kinds ofinformation. Network interface 2004 allows controller 2001 tocommunication externally, for example with a server such as pharmacyserver 101 described above.

Compounding assistance device 201 further includes infrared camera 404,barcode scanner 402, and visible light camera 403 as described above,all in communication with controller 2001 and under the control ofcontroller 2001. Infrared light source 302 and visible light source 405are also under the control of controller 2001, to be turned on and offat different times. In some embodiments, the intensity of the lightproduced by either or both light sources may be adjustable under thecontrol of controller 2001. Touchscreen display 208 can communicateinformation to a user of compounding assistance device 201, and canreceive instructions from the user.

Label printer 1303 receives commands and data from controller 2001 forthe printing of labels. Weight sensor 301 provides signals to controller2001 indicating the weight of tray 209 and any items on it.

Other architectures for compounding assistance device 201 may be used.

Additional information about compounding can be found in U.S. patentapplication Ser. No. 15/827,336 filed Nov. 30, 2017 and titled “IVCompounding Systems and Methods,” the entire disclosure of which ishereby incorporated by reference herein for all purposes.

With the above understanding of an example compounding process, it willbe recognized that many different compounding tasks are possible, usingdifferent numbers and combinations of ingredients. For example,different tasks may be defined for reconstituting and compoundingmedications received in powdered form, for medications to be deliveredin a syringe for direct injection, for diluting medications received inconcentrated form, or for other scenarios. More complex workflows may bedesigned for compounding multiple medications, for example placingmultiple medications in a single IV drip bag for simultaneous delivery.

In some embodiments, pharmacy server 101 may oversee a number ofpharmacies. For example, a single hospital may include a centralpharmacy and one or more satellite pharmacies connected with pharmacyserver 101. In other embodiments, pharmacy server 101 may overseemultiple pharmacies in multiple sites. For example, a number ofhospitals in a hospital group may share the services of pharmacy server101.

FIG. 21 schematically shows one example arrangement of multiplepharmacies in multiple facilities, all in communication with pharmacyserver 101, in accordance with embodiments of the invention. Firsthospital 2101 includes two pharmacies 2102 and 2103. Second hospital2104 includes a pharmacy 2105, and third hospital 2106 includes anotherpharmacy 2107. Each pharmacy houses one or more compounding devices, andstores medicines and supplies. Pharmacy server 101 may be incommunication with each of the pharmacies, even to the compoundingdevice level.

Besides the basic requirements of safety and accuracy, the efficientoperation of compounding pharmacies in a system such as the system shownin FIG. 21 is the subject of many considerations.

Order Scheduling and Delivery Considerations

Different medication orders may have different priorities. For example,some orders designated as “stat” orders may require immediatecompounding for delivery to a patient as soon as possible. Other ordersmay only need to be filled in due course, but of course should not besubject to unreasonable delay. For example, a “cart fill” order for aset of medications needed for a patient over the next few hours may befilled in due course. In some cases, medications may be prepared inbatches, for example “premade” medications. Premade medications may becompounded formulations that are used commonly enough to justifyaccumulating a supply of them in anticipation of use, rather thancompounding them for each individual order. Premades may be prepared inbatches during off hours or at other times when compounding capacity isavailable in one or more of the pharmacies.

Pharmaceutical Beyond Use Considerations

Medications typically have an allowable shelf life, often expressed as a“beyond use” date or time. The beyond use date is a date (or time) afterwhich the medication is not to be used, so as to avoid any risk of lossof effectiveness or other problems with the medication. A singlemedication may have several beyond use dates or times, depending on itsstate of use. For example, a vial of medication newly received directlyfrom the manufacturer may have a beyond use date weeks or months or morefrom the manufacturing date, so long as the vial remains unopened and isstored correctly. Once the vial is opened, it may have a viable shelflife of only hours or days, after which any unused amount should bediscarded. And once part of the contents of the vial have beencompounded into an IV drip bag, then the bag itself may have abeyond-use date or time measured from the time of compounding. Whenmultiple medications or ingredients are used in a single compoundingtask, then the beyond use date or time of the compounded formulation maybe the ingredient beyond use date or time nearest in the future.

Inventory Management Considerations

Different cooperating pharmacies may have different levels of inventoryat different times, which may be located at different physicallocations. It may be desirable to cooperatively adjust the management ofcompounding tasks to efficiently share inventory, while avoidingexcessive transportation of items between locations.

Facility Utilization Considerations

The assignment of compounding tasks may be adjusted to allow fordifferent operating times at different satellite pharmacies. Also,different pharmacies may have different equipment, some of which may bemore or less suited to certain compounding tasks than equipment at adifferent pharmacy. All else being equal, certain tasks may be allocatedto the pharmacy with the most suited equipment. In another example,different facilities may have different “off” hours than otherfacilities, when capacity may be available to perform batch compoundingto frequently-used formulations.

Compounding Management

In embodiments of the invention, pharmacy server 101 is programmed toassign compounding tasks to the various compounding devices, in light ofthe above and other considerations, with the goal of efficientlyachieving the greatest feasible number of compounding task completionswith the least feasible level of resource consumption, all on time andsafely. Pharmacy server 101 may be programmed with many rules in pursuitof this goal.

The ability of server 101 to implement its efficiency improvements isenabled in part by the fact that server 101 assigns or “pushes” thecompounding tasks to the compounding devices. In at least some priorarrangements, each compounder, upon completion of one compounding task,“pulls” the next available task from a queue. Because the individualcompounders do not have visibility to the entire flow of orders or tothe status of other pharmacies or facilities, a “pull” system cannotachieve the performance of a system having a global view andimplementing a “push” system, as in embodiments of the invention.

For example, when a batch compounding task is planned, server 101 mayrecognize that two different compounding devices are available to workon the task, but that the two have different historical speeds ofperformance. In a hypothetical example, compounding workstation 102 bmay be available, and may historically be able to complete onereplication of the task at hand in 5 minutes, when used by the operatoron duty. At the same time, robotic compounder 103 may be available, andmay be able to complete one replication in 4 minutes. In this example,we suppose that 20 units of the compounded formulation are ordered.Server 101 may allocate the batch preparation to either or both of thetwo devices, depending on current needs. For example, in order todeliver the entire batch most quickly, server may assign portions of thetask to both devices. However, if 10 units are assigned to each device,robotic compounder 103 will complete its 10 units in 40 minutes, whilethe operator at compounding station 102 b will require 50 minutes.Delivery of the entire order will have to wait on compounding station102 b after robotic compounder 103 is finished.

Server 101 may instead assign unequal portions of the task to the twodevices. In the above example, server 101 may assign 11 of the units torobotic compounder 103 and only 9 to compounding workstation 102 b.Robotic compounder 103 can complete its 11 units in 44 minutes, and theoperator at station 102 b can complete his or her 9 units in 45 minutes.The overall 20 units are available for delivery in 45 minutes—5 minutessooner than if equal portions of the task were assigned to the twoavailable devices. Within rounding error, server 101 in this exampleassigned portions of the task to the two devices such that the twoportions were completed at the same time.

A large number of such strategies are possible.

In another example, compounding tasks may be reordered or assigned ingroups to minimize the waste of pharmaceuticals. For example, a vial maycontain 50,000 units of a pharmaceutical, and two medication orders mayarrive at the pharmacy for compounding the pharmaceutical into IV dripbags—one containing 30,000 units of the pharmaceutical and onecontaining 20,000 units. If these two orders are simply assigned insequence to the next available compounding devices, each of the devicesmay use a vial of the pharmaceutical, wasting 20,000 units at one deviceand 30,000 units at the other. Instead, server 101 may advance one ofthe others out of turn so that both can be assigned to the samecompounding device and filled from the same 50,000 unit vial, resultingin no waste. Even if the two orders were assigned to the samecompounding device but separated in time, waste could still occur if theshelf life of the opened vial is exceeded between tasks. The reorderingof the tasks to occur in immediate sequence helps avoid this potentialfor waste as well.

Similarly, if several orders are received for compounding the samemedication for different patients, these orders may be grouped andassigned to the same compounding device. In this way, supplies for themultiple orders may be pulled simultaneously and the compounding tasksmay be performed without switchover time at the compounding device.

Server 101 may include the scheduled dosage times of the compoundedformulations in its assignment rules as well. For example, in thescenario above, the two compounding tasks can also be scheduled so thatboth compounded IV bags can be delivered to their respective patientsduring the shelf life of the completed bags. In other words, it can alsobe important not to complete a compounding task too early, and risk thecompounded formulation being unusable by the scheduled time ofadministration.

In another example, server 101 may assign compounding tasks toparticular pharmacies, for example to avoid waste. For example, server101 may keep or have access to inventory records of multiple pharmaciessuch as pharmacies 2102, 2103, 2105, and 2107, and may recognize thatthe stock of a particular pharmaceutical at one of the pharmacies isolder than the stock at another of the pharmacies, and may beapproaching its beyond use date. Server 101 may receive an order forcompounding of the pharmaceutical, and may assign the compounding taskto the pharmacy with the oldest viable stock, presuming that thecompounded formulation can be delivered to the patient timely. In otherembodiments, server 101 may consider the locations of the variouspharmacies in this situation. For example, a “stat” order may not beassigned to a pharmacy in a different hospital than the patient for whomit is prescribed, because the time required to transport the compoundedformulation back to the patient's hospital may be too long to meet the“stat” requirement. In this case, the order may be assigned forcompounding in the same hospital as the patient, even though fulfillingthe order in the same hospital may result in waste at another hospitalas the same pharmaceutical goes past its beyond use date.

Similarly, server 101 may direct that a pharmaceutical be taken fromsmaller, more-expensive-per-unit vials than available larger,less-expensive-per-unit vials if the smaller vials are near theirbeyond-use date and may otherwise be wasted.

In another example, smaller, more-expensive-per-unit vials may be usedif there is no convenient stock of the larger, less-expensive-per-unitvials, in order to meet compounding deadlines. In some embodiments, itmay be acceptable to substitute an in-stock ingredient for a prescribedout-of-stock ingredient. For example, an IV drip bag with a differentdiluent than specified in the order may be substituted, preferably withpharmacist and/or physician approval. In some cases, server 101 may keepa list of approved substitutions.

Another management technique is the use of a premade formulation, whenavailable, instead of performing a one-off compounding task. In othersituations, a particular pharmacist or physician may specify that afresh formulation be prepared in a specific case, even though a premademight be available.

Server 101 may consider patient demographics in the assignment ofcompounding tasks. For example, dose accuracy may be especially criticalin pediatric care. When an order is received for a compoundedformulation for a young child, a new formulation may be required to beprepared using a protocol with specific checks on the dose accuracy,even though a premade version of the same formulation is in stock, madeaccording to a less stringent protocol and suitable for an adultpatient. One way in which this situation may arise is an order for apediatric dose in which the prescription translates into a dose volumeof less than 2 ml. Because the measurement uncertainty of gravimetricverification may be as large as 10 percent or more at such smallvolumes, a protocol using photographic verification may be specified,showing the syringe plunger position, rather than using gravimetricverification. This decision could also be made based on the specificdrug being prescribed. For example, insulin is often prescribed in dosesof less than 1 ml, such that photographic verification may be especiallyappropriate.

In the case of a particularly critical drug or dose size, server 101 mayallow the specification of an in-workflow review, in which a secondtechnician is called to review the work of the first and must entertheir credentials for the prep to be approved.

In some embodiments, server 101 may consider the time of day, day of theweek, day of the month, or other temporal data in assigning compoundingtasks. In a simple example, a hospital main pharmacy may operate 24hours per day, while a satellite pharmacy may close at night. Server 101may assign a compounding task to the satellite pharmacy closest to theintended patient if the task can be completed during the operating hoursof the satellite pharmacy. Otherwise, the task may be assigned to themain pharmacy, even though delivery will require more transportationtime and effort. Similarly, tasks may be assigned to pharmacies indifferent facilities depending on operating hours.

The time of day, week, or month may be considered for other reasons aswell. For example, a suburban pharmacy may historically have low demandfor compounding on weekday afternoons as compared with a pharmacy in anurban setting. The suburban pharmacy may therefore be available toaccept batch compounding tasks during weekday afternoons.

In some embodiments, server 101 may consider the kind of packages inwhich compounded medications will be delivered in assigning compoundingtasks. For example, a series of similar tasks that are suitable forcompounding by a robotic compounder may be grouped together and assignedto a particular robotic compounder, while “one-off” compounding tasksmay be assigned to workstations with human operators. In some cases,certain delivery packages are simply more amenable to human compounding,for example ampoules, elastomeric pumps, and syringes of unusual size.Compounding tasks involving these delivery vehicles can be assigned todevices with human operators.

Preferably, server 101 can adapt in real time to changing conditions inthe pharmacies within its purview. For example, in the event of anequipment breakdown or sudden operator illness, tasks scheduled forassignment to the failed compounding device can be reassigned to otherdevices.

The above strategies include further examples of the advantage of a“push” assignment system, as opposed to the traditional “pull” system.Pharmacy server 101 has visibility of inventories at the variouscompounding locations, and can “see” a broader range of incomingmedication orders. It can therefor assign compounding tasks in such away as to maximize the utilization of existing inventories, for examplesending orders for the same medication to the same compounding device,so as to fully use a vial, or to use a medication near its beyond usedate. A “pull” system in which each device or site has visibility onlyto its own location would not be able to achieve the same efficiencies.

In another example advantage, server 101 has visibility to the usage ofcompounding devices at multiple locations, and can assign tasks to takeadvantage of otherwise-idle devices or to offload devices that wouldotherwise be overloaded. A pull system would not be able to make thesechoices.

In another example advantage, the push system can assign portions of arepetitive batch compounding task to different devices, in proportionsthat maximize the overall speed of completion of the task.

The technical effect of such a system is more efficient utilization ofassets and inventory that may be possible with a pull system, throughload balancing and efficient inventory usage.

FIGS. 22 and 23 illustrate additional technical details usable inembodiments, implemented as a resource control system 2200. Resourcecontrol system 2200 may be used to implement the methods and techniquesdisclosed herein. FIG. 22 depicts a high-level block diagram of theresource control system 2200, in accordance with disclosed embodimentsof the present disclosure. The resource control system 2200 mayfacilitate resource balancing and notifications relating to resourcebalancing based at least in part on resource capacities and assignmentsof operations to resources. In various embodiments, the resource controlsystem 2200 may facilitate resource balancing, notifications, andcontrol relating to resource balancing based at least in part on eventrecognition, as well. The resource control system 2200 may include anadaptive processing and control system 2201. The adaptive processing andcontrol system 2201 may aggregate and/or determine resource metrics andinstantaneous resource state information to dynamically assess resourcebalance and demand. The adaptive processing and control system 2201 mayintelligently manage loads based at least in part on resource models,which may define resources load processing specifications.

In various embodiments, the adaptive processing and control system 2201may provide resource management control via onsite and/or offsiteresource control gateways. As depicted, the resource control system 2200may allow for interaction between two or more of an adaptive processingand control system 2201, request interfaces 2208, and a plurality ofresources interfaces 2202, which may include one or more supply resourceinterfaces 2204, one or more robotic compounder interfaces 2203, and oneor more guided compounder interfaces 2202 a, 2202 b. As disclosedherein, the one or more robotic compounder interfaces 2203 and one ormore guided compounder interfaces 2202 a, 2202 b may correspond to oneor more compounding stations, which may include robotic compounders andguided compounding stations. As depicted, components of the resourcecontrol system 2200 may be communicatively coupled or couplable to oneor more networks 2210.

The one or more networks 2210 may be a suitable means to facilitate datatransfer in the resource control system 2200 and could include multiplenetworks and/or network components. In various embodiments, the one ormore networks 2210 may be implemented with, without limitation, one ormore of the Internet, a wide area network (WAN), a local area network(LAN) such as one based on Ethernet, a virtual private network (VPN), anintranet, an extranet, Token-Ring and/or the like, an infra-red network,a wireless network (e.g., a network operating under Bluetooth®, any ofthe Institute of Electrical and Electronics (IEEE) 802.11 suite ofprotocols, and/or any other wireless protocol), a wireless local areanetwork (WLAN), a cellular network, such as through 1G, 3G, GSM (GlobalSystem for Mobile Communications), etc., another wireless network, agateway, a public switched telephone network (PSTN), common enterprisenetwork, and/or any other appropriate architecture or system thatfacilitates the communication of signals, data, and/or message. Invarious embodiments, the one or more networks 2210 may transmit datausing any suitable communication protocol(s), such as, withoutlimitation, TCP/IP (transmission control protocol/Internet protocol),SNA (systems network architecture), IPX (Internet packet exchange),AppleTalk, and/or the like. In various embodiments, the one or morenetworks 2210 and its various components may be implemented usinghardware, software, and communications media such wires, optical fibers,microwaves, radio waves, and other electromagnetic and/or opticalcarriers; and/or any combination of the foregoing and/or the like. Insome embodiments, the network 2210 may include a telephone network thatmay be circuit switched, package switched, or partially circuit switchedand partially package switched.

In various embodiments, the adaptive processing and control system 2201may include a set of devices configured to process, transform, encode,translate, send, receive, retrieve, detect, generate, compute, organize,categorize, qualify, model, store, display, present, handle, or useinformation and/or data suitable for the embodiments described herein.The adaptive processing and control system 2201 may include a serversystem comprising one or more servers, each comprising one or moreprocessors and memory. For example, one or more servers of the system2201 may be used to store software programs and data. Softwareimplementing the systems and methods described herein may be stored onstorage media in the servers. Thus, the software may be run from thestorage media in the servers. For example, memory of one or more of theservers may hold instructions that, when executed by one or moreprocessors, cause a load-balancing server to perform its functions inaccordance with embodiments of the invention. The storage may also storethe records, protocols, and other information collected and generated inthe operation of system 2200. For the purposes of this disclosure, theterm “memory” encompasses many different kinds of data storage devicesand combinations of such devices, for example dynamic memory, staticmemory, volatile memory, nonvolatile memory, and mass storage such asmagnetic or optical disk storage or tape storage. In variousembodiments, software implementing the systems and methods describedherein may be stored on storage media of other devices described herein.

In some embodiments, the resource control system 2200 may be adistributed system for implementing features of various embodimentsdisclosed herein. The resource control system 100 may include orotherwise interface with one or more interface devices 2208-1, 2202-1,2203-1, 2204-1, and/or 2205 depicted in FIG. 22 . FIG. 23 shows adiagram of a portion of an architecture stack of the system 2201, inaccordance with certain embodiments of the present disclosure. Thearchitecture stack of FIG. 23 may also be used in implementations of themethods and techniques described herein. At least some of the interfacedevices 2208-1, 2202-1, 2203-1, 2204-1, and/or 2205 may be configured toexecute and operate a client application such as a web browser,proprietary client interface, application programming interface, and/orthe like over one or more networks 2210. Thus, the system 2201, whichmay include a server system including one or more servers in someembodiments, may be communicatively coupled with remote interfacedevices 2208-1, 2202-1, 2203-1, 2204-1, and/or 2205 via the network2210.

In various embodiments, the adaptive processing and control system 2201may be adapted to run one or more services or software applicationsprovided by one or more of the components of the system. In someembodiments, these services may be offered as web-based or cloudservices or under a Software as a Service (SaaS) model to the users ofremote interface devices 2208-1, 2202-1, 2203-1, 2204-1, and/or 2205.Users operating remote interface devices 2208-1, 2202-1, 2203-1, 2204-1,and/or 2205 may in turn utilize one or more client applications tointeract with the adaptive processing and control system 2201 to utilizethe services provided by these components.

Software components of the resource control system 2200 may beimplemented on the adaptive processing and control system 2201—e.g., onone or more servers. In addition or in the alternative, one or more ofthe components of resource control system 2200 and/or the servicesprovided by these components may be implemented by one or more of theinterface devices 2208-1, 2202-1, 2203-1, 2204-1, and/or 2205. Usersoperating the interface devices 2208-1, 2202-1, 2203-1, 2204-1, and/or2205 may then utilize one or more client applications to use theservices provided by these components. These components may beimplemented in hardware, firmware, software, or combinations thereof. Itshould be appreciated that various different system configurations arepossible, which may be different from the resource control system 2200.The embodiment shown in the figure is thus one example for implementingcertain embodiments and is not intended to be limiting.

Referring again to FIG. 22 , the adaptive processing and control system2201 may include one or more load-balancing servers, data acquisitionservers, application servers, resource data management servers, and/orthe like, one or more of which may include one or more load-balancingprocessors. The server system may be located remotely and/or locallywith respect to one or more sites that generate, maintain, supply,and/or otherwise provide resources. The server system may acquireinformation, manage, and/or control site components of one or moresites, e.g., via resource interfaces 2202. For example, resourcedescriptions, resource states, resource attributes, and/or the like topush and/or pulled from one or more sites via resource interfaces 2202.Some embodiments may include implementing one or more on-site gatewaysproviding information, management, and/or control of site components.

In various embodiments, one or more of the resource interfaces 2202 mayallow for communication with one or more data sources, with the one ormore interfaces 2202 configured to operate as one or more eventmonitors. The server system may correspond to, include, or otherwiseutilize one or more event monitors to actively retrieve and/or otherwisereceive data from one or more data sources. The one or more data sourcesmay include any suitable source of data to facilitate embodimentsdisclosed further herein.

In various embodiments, the data from the one or more data sources maybe retrieved and/or received by the adaptive processing and controlsystem 2201 via the one or more event monitors through network(s) 2210and/or through any other suitable means of transferring data. In someembodiments, the adaptive processing and control system 2201 and thedata sources could use any suitable means for direct communication.According to certain embodiments, data may be actively gathered and/orpulled from one or more data sources, for example, by accessing a thirdparty repository and/or by “crawling” various repositories. Certain datapulled and/or pushed from the one or more data sources may betransformed and the transformed data and/or other data generated asdisclosed herein.

In various embodiments, one or more of the resource interfaces 2202 mayinclude one or more gateways and/or application programming interfaces(APIs) that define protocols and routines for interfacing with the datasources. The APIs may specify application programming interface (API)calls to/from data source systems. Some embodiments may employ one ormore web APIs. In some embodiments, the APIs may include a plug-in tointegrate with an application of a data source system. The one or moreof the resource interfaces 2202, in some embodiments, could use a numberof API translation profiles configured to allow interface with the oneor more additional applications of the data sources to access data(e.g., a database or other data store) of the data sources. The APItranslation profiles may translate the protocols and routines of thedata source system to integrate at least temporarily with the system andallow communication with the system by way of API calls. Data, asreferenced herein, may correspond to any one or combination of raw data,unstructured data, structured data, information, and/or content whichmay include media content, text, documents, files, instructions, code,executable files, images, video, audio, and/or any other suitablecontent suitable for embodiments of the present disclosure.

According to certain embodiments, the adaptive processing and controlsystem 2201 may include or provide a resource administratory platform.An administratory device may receive notifications and/or access theadaptive processing and control system 2201 via one or more requestinterfaces 2208. In some embodiments, resource interfaces 2202 mayinterface with resource-controlling systems at remote sites.

In some embodiments, one or more request interfaces 2208 and/or aresource interfaces 2202 may include a web interface, which may, forexample, allow for real-time and scheduled changing of resourceassignments and schedules. The client interfaces 2205 and/or resourcedata interfaces 2202 may allow for transfer of and access to informationin accordance with certain embodiments disclosed herein. In variousembodiments, the request interfaces 2208 and/or resource interface(s)2202 may include one or more suitable input/output modules and/or othersystem/devices operable to serve as an interface between users and theresource administratory platform. The request interfaces 2208 and/orresource interface(s) 2202 may facilitate communication over the network2210 using any suitable transmission/ communication protocol and/orstandard.

In various embodiments, the system 2201 may include, provide, and/or beconfigured for operation with the request interfaces 2208 and/orresource interface(s) 2202, for example, by making available and/orcommunicating with one or more of a website, a web page, a web portal, aweb application, a mobile application, enterprise software, and/or anysuitable application software. In some embodiments, a request interfaces2208 and/or resource interface(s) 2202 may include an API to interactwith the interaction system 2201.

In some embodiments, the request interfaces 2208 and/or resourceinterface(s) 2202 may include or work with an application made availableto one or more interfaces, such as a mobile application as discussedherein. In some embodiments, the request interfaces 2208 and/or resourceinterface(s) 2202 may cause a web page to be displayed on a browser. Theweb page(s) may display output and receive input from a user (e.g., byusing Web-based forms, via hyperlinks, electronic buttons, etc.). Avariety of techniques can be used to create the web pages and/ordisplay/receive information, such as JavaScript, Java applications orapplets, JSON, dynamic HTML, and/or AJAX technologies. Accordingly, theadaptive processing and control system 2201 may have website(s)/portal(s) giving access to such information, such as anadministratory portal. In various embodiments, a request interfaces 2208and/or resource interface(s) 102 may include providing one or moredisplay screen images that may each include one or more user interfaceelements. A user interface may include any text, image, and/or devicethat can be displayed on a display screen for providing information to auser and/or for receiving user input. A user interface may include oneor more widgets, windows, dashboards, text, text boxes, text fields,tables, grids, charts, hyperlinks, buttons, lists, combo boxes,checkboxes, radio buttons, and/or the like.

Referring again to FIG. 23 , the depicted portion at least partiallyincludes an application/device layer, as well as a load-balancingapplication services system 2341 and a load-balancing data managementsystem 2366 of the system 2201. In some embodiments, the load-balancingapplication services system 2341 may correspond at least partially to aninterface layer and a load-balancing application services managementlayer. In some embodiments, the data storage system may correspond atleast partially to a load-balancing data storage layer.

The load-balancing application services system 2341 may interface withthe application/device layer 2210 and the load-balancing data storagesystem 2366. In some embodiments, the load-balancing applicationservices system 2341 may include at least part of the application/devicelayer 2210. The load-balancing application services system 2341 could bea middle tier of the interaction system 2201 in some embodiments, withthe load-balancing data storage system 2366 corresponding to a back-endin some embodiments.

In some embodiments, the load-balancing application services system 2341and the load-balancing data storage system 2366 each may be or include aload-balancing server system 2345 and a resource data management serversystem 2367, respectively, that include one or more servers. Otherembodiments may include only a single server system. In someembodiments, the load-balancing application services system 2341 and theload-balancing data storage system 2366 may be integrated. In variousembodiments, the server systems 2345, 2367 may include one or morecomputers, specialized server computers (including, by way of example,load-balancing servers, load control servers, other site controlservers, data acquisition servers, application servers, data managementservers, PC (personal computer) servers, UNIX® servers, mid-rangeservers, mainframe computers, rack-mounted servers, etc.), server farms,server clusters, or any other appropriate arrangement and/orcombination. In various embodiments, the server systems 2345, 2367 maybe adapted to run one or more services, operations, processing, orsoftware applications described herein. The server systems 2345, 2367may also run any of a variety of additional server applications and/ormid-tier applications, including the examples disclosed above, forexample, with respect to server 2312.

In some embodiments, the server systems 2345, 2367 may include one ormore applications to pull, receive, analyze, aggregate, and/orconsolidate data feeds and/or event updates received from various datasources. As an example, data feeds and/or event updates may include, butare not limited to, application 2206, 2208, 2312, and/or 2312-1 updatesand/or data feeds, interfaces/devices updates and/or data feedscorresponding to the depicted feedback communications, which may includereal-time events and/or data feeds related to sensor systems and/orcomponents thereof, updates (real-time and/or otherwise) received fromone or more third party information sources and/or continuous datastreams, and/or the like. The server system 2345 may also include one ormore applications to display the data feeds and/or real-time events viathe interfaces/devices and/or devices internal to the adaptiveprocessing and control system 2201.

The application services system 2341 and/or the data management system2366 may also include one or more resource data storages 2368. Theresource data storages 2368 may include various forms of data storageincluding solid state storage, disk storage, databases (includingrelational, column, document, key-value and graph type databases) andcache. The resource data storages 2368 may reside in a variety oflocations, such as on a non-transitory storage medium local to (and/orresident in) the server systems 2345, 2367 and/or remote from the serversystems 2345, 2367 and in communication with the server systems 2345,2367 via a network-based or dedicated connection. In certainembodiments, the resource data storages 2368 may reside in astorage-area network (SAN). Similarly, any necessary files forperforming the functions attributed to the server systems 2345, 2367 maybe stored locally on the server systems 2345, 2367 and/or remotely, asappropriate. In one set of embodiments, the resource data storages 2368may include relational databases that are adapted to store, update, andretrieve data in response to SQL-formatted commands. It should beappreciated that information corresponding to the repositories may bestored elsewhere and/or in other ways, or may not be stored, dependingon the implementations chosen. Likewise, while various segregations ofdata corresponding to the repositories are provided herein, it should beappreciated that such examples are non-limiting, and some or all thedata may be handled in any suitable manner.

In certain embodiments, the adaptive system 2201 may be implemented inor with a distributed computing and/or cloud computing environment witha plurality of servers and cloud-implemented processing, memory, anddata resources. Thus, with accretion of service information, the systemmay allow for scaling out with additional processing resources, serverresources, data storage resources, data management resources, and thelike. Some embodiments may use different types of servers to servicedifferent types of interface devices. The adaptive system 2201 mayprovision services facilitated by one or more components of the adaptivesystem 2201, and, in some embodiments, one or more of the services maybe offered as cloud services. A specific instantiation of a serviceprovided by the adaptive system 2201 may be referred to herein as aservice instance. In some examples, a service provided by the adaptivesystem 2201 may include control communications, which may correspond toany one or combination of communications disclosed herein such ascommunications to effect resource assignment, resource assignment suchas assignment nullification, modification, reassignment, etc.

In the illustrated embodiment, one or more interface devices may be usedby users to interact with the adaptive system 2201. Although only alimited number of the interface devices is shown, any number ofinterface devices may be supported. In various embodiments, theinterface devices may correspond to the request interfaces 2208 and/orresource interfaces 2202. In various embodiments, the interface devicesmay include site component controllers and/or site components asdisclosed further herein.

According to a first embodiment, a system for compounding of medicationscomprises a plurality of compounding devices, each of the plurality ofcompounding devices selected from the group of compounding devicesconsisting of a compounding assistance device, a robotic compounder, anda hazardous drug robotic compounder, and each of the plurality ofcompounding devices being computerized. The system further comprises acentral server computer, and each of the plurality of compoundingdevices is in bidirectional communication with the central servercomputer via an electronic network. The central server computer and theplurality of compounding devices are configured to cooperativelyreceive, at the central server computer, a plurality of requests, atleast some of which require the compounding of one or more medications;push, by the central server computer via the electronic network,assignments of respective compounding tasks to the plurality ofcompounding devices; and perform or guide, using the compoundingdevices, the respective directed compounding operations. The centralserver computer is configured to assign respective compounding tasks tothe plurality of compounding devices in accordance with a set of rulesdesigned to promote efficient use of compounding resources and avoidwaste.

According to a second embodiment, the plurality of compounding devicesin the first embodiment reside within a single pharmacy.

According to a third embodiment, the plurality of compounding devices inthe first embodiment are distributed among multiple pharmacies within asingle facility.

According to a fourth embodiment, the plurality of compounding devicesin the first embodiment are distributed among multiple facilities.

According to a fifth embodiment, the central server computer in any ofthe above embodiments is configured to assign respective compoundingtasks to the plurality of compounding devices in accordance with a rulethat considers the physical locations of the plurality of compoundingdevices.

According to a sixth embodiment, the set of rules in any of the aboveembodiments is configurable.

According to a seventh embodiment, the set of rules in any of the aboveembodiments comprises one or more rules for reordering or groupingrequests so as to avoid waste.

According to an eighth embodiment, the central server computer in any ofthe above embodiments is configured to assign respective portions of abatch compounding task to at least two of the plurality of compoundingdevices, wherein the respective portions of the batch compounding taskassigned to each of the at least two compounding devices are selectedbased at least on part on performance records of the at least twocompounding devices, such that the portions of the batch compoundingtask assigned to the at least two compounding devices are expected to becompleted at the same time.

According to a ninth embodiment, compounding tasks are assigned in anyof the above embodiments based at least in part on a beyond use date ortime of a particular pharmaceutical.

According to a tenth embodiment, compounding tasks in any of the aboveembodiments are assigned based at least in part on one or more of a timeof day, day of the week, or day of the month at which a particularcompounding task is to be performed.

According to a eleventh embodiment, at least one batch compounding taskis assigned in any of the above embodiments in a way that utilizes acompounding device for preparation of a batch of compounded formulationwhen the compounding device would otherwise be idle.

According to a twelfth embodiment, compounding tasks are assigned in anyof the above embodiments based at least in part on patient demographics.

According to a thirteenth embodiment, at least some compounding tasksinvolving the same pharmaceutical are grouped and assigned in any of theabove embodiments to be performed on a single compounding device.

According to a fourteenth embodiment, the central server computer isconfigured in any of the above embodiments to maintain records of theperformance of each of the plurality of compounding devices, andcompounding tasks are assigned to the compounding devices based at leastin part on the records.

According to a fifteenth embodiment, the plurality of compoundingdevices in any of the above embodiments includes at least onecompounding assistance device comprising: a carrier for supportingitems, wherein the material of the carrier is not opaque to infraredlight; an infrared digital camera positioned to photograph at least aportion of the carrier from above; an area light source positioned underthe carrier, the area light source configured to generate infrared lightand direct the infrared light through the carrier and toward the digitalcamera; a display; a weight sensor on which the carrier rests, theweight sensor configured to produce a signal indicating the weight ofthe carrier and any items on the carrier; a visible light camerapositioned to photograph at least a portion of the carrier from above;and a controller configured to guide a user of the compoundingassistance device through a pharmaceutical compounding task using one ormore prompts shown on the display.

According to a sixteenth embodiment, a method of load balancing in acompounding system comprises receiving, at a central server computer, aplurality of requests, at least some of which require the compounding ofone or more medications. The method further comprises monitoring theavailability and performance of a plurality of compounding devices, eachof the plurality of compounding devices selected from the group ofcompounding devices consisting of a compounding assistance device, arobotic compounder, and a hazardous drug robotic compounder, and each ofthe plurality of compounding devices being computerized. The methodfurther comprises, for each of the requests requiring compounding:selecting one of the plurality of compounding devices to which to assignthe task of compounding the medication, the selection being performed inaccordance with a set of rules designed to promote efficient use ofcompounding resources and avoid waste; transmitting an electronicmessage assigning the task of compounding the medication to the selectedcompounding device; and performing or guiding, using the selectedcompounding device, the assigned compounding task.

According to a seventeenth embodiment, the plurality of compoundingdevices in the sixteenth embodiment all reside in a single facility.

According to an eighteenth embodiment, the plurality of compoundingdevices in the sixteenth embodiment are distributed among multiplefacilities.

According to a nineteenth embodiment, for at least a particular one ofthe requests in any of the sixteenth to eighteenth embodiments, theselected compounding device is a robotic compounder, and the methodcomprises, performing the assigned compounding task using the roboticcompounder.

According to a twentieth embodiment, the method of any of the sixteenthto nineteenth embodiments further comprises tracking inventory levels ofmedicines at one or more locations, and selecting one of the pluralityof compounding devices to which to assign a particular task comprisesselecting the compounding device based at least in part on the inventorylevels.

According to a twenty-first embodiment, the plurality of compoundingdevices in any of the seventeenth to twentieth embodiments aredistributed among multiple facilities.

In the claims appended hereto, the term “a” or “an” is intended to mean“one or more.” The term “comprise” and variations thereof such as“comprises” and “ comprising,” when preceding the recitation of a stepor an element, are intended to mean that the addition of further stepsor elements is optional and not excluded. It is to be understood thatany workable combination of the elements and features disclosed hereinis also considered to be disclosed.

The invention has now been described in detail for the purposes ofclarity and understanding. However, those skilled in the art willappreciate that certain changes and modifications may be practicedwithin the scope of the appended claims.

What is claimed is:
 1. A method of compounding a medication, the methodcomprising: receiving a syringe into a viewing area between an infraredarea light source and an infrared digital camera; taking a first digitalphotograph of the syringe in infrared light using the infrared digitalcamera, wherein the infrared area light source emanates light directlytoward the infrared digital camera such that the syringe is backlit bythe infrared area light source; automatically analyzing the digitalphotograph to ascertain whether a needle is attached to the syringe, orautomatically analyzing the first digital photograph to ascertainwhether a needle cap is attached to the syringe; and storing the digitalphotograph.
 2. The method of claim 1, further comprising automaticallyanalyzing the digital photograph to compute a volume of liquid in thesyringe.
 3. The method of claim 1, further comprising automaticallyanalyzing the digital photograph to ascertain the size and position ofthe syringe in the digital photograph; and annotating the digitalphotograph with volume indications.
 4. The method of claim 1, wherein:the infrared area light source and the infrared digital camera arecomprised in a compounding assistance device; and receiving the syringebetween the infrared area light source and the infrared digital cameracomprises receiving the syringe manually from a user of the compoundingassistance device.
 5. The method of claim 4, wherein the compoundingassistance device comprises a display and a controller, and the methodfurther comprises leading the user of the compounding assistance devicethrough a compounding task using a series of prompts shown on thedisplay.
 6. The method of claim 1, wherein: the infrared area lightsource and the infrared digital camera are comprised in a compoundingrobot; and receiving the syringe between the infrared area light sourceand the infrared digital camera comprises receiving the syringe from arobotic mechanism.
 7. The method of claim 1, wherein the digitalphotograph is a first digital photograph, the method further comprising:taking a second digital photograph of a container involved incompounding using a visible light camera; and storing the second digitalphotograph in association with the first digital photograph.
 8. Themethod of claim 7, wherein taking the second digital photographcomprises taking a color photograph.
 9. A pharmaceutical compoundingdevice, comprising: an infrared area light source; an infrared digitalcamera; a visible light digital camera; a source of visible lightpositioned adjacent the visible light digital camera; a viewing areabetween the infrared area light source and the infrared digital camera;and a controller programmed to control the infrared area light sourceand the infrared digital camera to take a first photograph of an item inthe viewing area such that the item is backlit by the infrared arealight source, and to take a second photograph of the viewing area usingthe visible light digital camera, and to control the source of visiblelight.
 10. The pharmaceutical compounding device of claim 9, wherein:the pharmaceutical compounding device is a compounding assistance devicecomprising a display; and the controller is further programmed to guidea user of the device through a compounding task using prompts shown onthe display.
 11. The pharmaceutical compounding device of claim 9,wherein the pharmaceutical compounding device is a compounding robot.